الفهرس 
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Abstract
Proximal tibial fracture is a common injury. These fractures represent
surgical challenge because of the variety of fracture patterns and the
associated soft tissue injuries. If not adequately treated, these fractures
often cause persistent knee pain, arthritis, stiffness and angular
deformity.
Non articular proximal fractures account for 5% to 11% of the total
number of tibial injuries. Fractures of the tibial plateau represent 1%
of all fractures and 8% of fractures in elderly population.
A newer concept of internal fixation, the locking compression plate
(LCP) was introduced to overcome the drawbacks of conventional
plating systems. This system provides angular stability with locking
screws . The LCP system consists of a range of anatomically shaped
plates with specially designed combination holes. The unique design
of these combination holes allows the system to be used both as a
conventional compression plate and as a locked internal fixator, it
also allows internal fixation with a combination of conventional and
locking head screws.
Aim of the work
Evaluation of the locked plate fixation of proximal tibial fractures
in adult patients .
MATERIALS AND METHODS
This work is a prospective study of thirty patients with proximal tibial
fractures treated by locked compression plates at El Menofiya
university Hospital during the period from February 2012 to July
2013.The fractures were classified using the method of AO
classification. We used Locking compression plate (T plate, L
plate and Hockey stick plate ) and locking or non locking screws
were used.
supplementary use of Inter fragmentary screws may be required
to prevent loss of reduction and to ensure adequate compression of the
fractures.
Spinal anaesthesia was the used type of anaesthesia in all cases.
Position of the patient was supine on a radiolucent operating table.
The leg should be freely movable. Visualization of the proximal tibia
under fluoroscopy in both the lateral and AP views is necessary.
Support the knee with towels to flex it into the appropriate position
and tourniquet was used in all cases.
The technique of surgery was ORIF(open reduction internal fixation)
or MIPO(minimally invasive plate osteosynthesis).
RESULTS
The majority of fractures occurred between the age of 20 to 65 years
with the maximum incidence involving the productive age group 20
to50 years(76.67%).
In this study the majority of fractures occurred in males(90%),
and the commonest mode of injury being RTA (83.33%). In laterality
of the fracture being left side(60%). The type of fracture determined
according to AO classification system, were type A and type C being
most predominant (46.67%, 36.67%) especially type A2 and type
C1(30%,26.67%) respectively . The ORIF technique had done in 21
patients(70%), using the anterolateral approach in 20 patients, anterior
mid line approach in one patient and MIPO technique had done in 9
patients(30%), using anteromedial incision in 6 patients as it easy to
perform MIPO technique and using anterolateral incision in 3 patients.
And there were 21 patients from 30 patients (70%) had no pain, (70%)
had normal walking capacity, (90%) had ROM of the knee joint ≥90⁰,
and all patients had normal stability of the knee joint.
The end results were achieved 70% excellent and
23.33%good(over all 93.33% Acceptable result), in addition there
were 6.67%fair(Unacceptable result).
These results in term of functional outcome according to Rassmusen
scoring system.
DICUSSION
Proximal tibial fractures, one of the commonest intra articular
fractures, incidence of these fractures are increasing regularly due to
RTA and at the same time surgical treatment options also being
modified continuously.
To overcome these difficulties and to early restoration of strength of
bone and function of knee joint with minimal injury to soft tissues,
The development of the LCP, which has been available for clinical
use since 2001.
In this study all patients had excellent union except one developed
nonunion whose had been nine months follow-up then lost follow-up.
And All fractures united without bone graft, (90%) had ROM of the
knee joint ≥90⁰. And there were 26 patients (86.67%) had no
complications and 4 patients (13.33%) had complications ; two cases
had knee stiffness, one develop nonunion, and the last had infection
that may be due to uncontrolled DM.
In the end of this study, we found that the use of LCP lead to reduce
complication rate and achieved acceptable result about (93.33%).
These results are comparable with others documented studies.
Conclusions
The proximal tibial fractures need optimum treatment as most of
them involve the productive age group.
The LCP can used for different techniques and biomechanical
principles:
A conventional technique (compression principle)
Bridging technique (internal fixator principle)
Combination technique (compression and bridging)
Bone graft is not essential for defect in metaphyseal region as LCP
internal fixator system act as single implant and prevent collapse of
fracture intra operatively and postoperatively subsequently bone
deficient will heal by callus formation.
The correct use of LCP with proper technique and proper instruments
is mandatory Otherwise, complications will arise.
The LCP encourage early rang of motion at knee joint as it provide
stable fixation.
Thus LCP seem to provide a new option for the treatment of proximal
tibial fractures especially in comminuted and articular fractures.